Brain Metastases   

Controlled extracranial disease on trastuzumab+pertuzumab for 2 years. Treatment options include Enhertu or WBRT. Not a candidate for SRS or neurosurg...

Would you offer consolidative brain SRS, SRS + consolidative RT to the primary (e.g. lung), consolidative RT to the primary alone?

If so, how many days before and after? Does this change if delivering SRS?

Do all patients with brain metastases get started on anticonvulsants?  Do you decide based on extent of edema, tumor size, or something else?&nb...

This has become standard practice at our institution for patients with a good performance status, with whole brain radiotherapy given after the comple...

What is your GTV, CTV and PTV? If giving 30 Gy in 10 fx, does the contour need to extend all the way to the cut in the skull on both sides (is there a...

With targeted therapies available, is there a utility for post-op SRS to the resection cavity? 

In patients with contraindications to receiving an MRI scan, are other imaging modalities sufficient to treat patients with SRS?

Based on recent ASTRO data, what is your selection criteria and size cutoffs?

How often are you scanning the brain and what is your trigger to treat?

What maximum dose do you allow to “connect” adjacent metastatic lesions receiving SRS/SRT? What is this value for one-, three-, and five-...

Is there evidence that supports/refutes the safety of concurrent use?

CNS recurrence occurred within two years of prior neoadjuvant therapy

The patient is treatment naïve and asymptomatic. She also has disease in the body (bone and liver metastases). 

How does the presence of prior WBRT alter your treatment plan?

Patient completed neoadjuvant therapy with TCH 2 years prior, and has no evidence of disease outside the CNS on PET/CT.

A HA-WBRT patient developed brisk mucositis on the soft palate at fraction 8/10

How should they be prioritized? V10, V12, mean brain dose, prior WB radiation? To what extent should tumor coverage, conformality and homogeneity be c...

Would this be any different for whole brain radiotherapy?

Can SRS or whole brain radiotherapy be reserved for progression in these young, healthy patients?

Do you increase dosage of the TKI or switch to a different generation TKI?  How does your answer differ for EGFR vs. ALK, and for discerete brain...

Do you modify your dose/fractionation depending on the amount of prior intrathecal therapy?

There are solid data from Emory, Korea and others suggesting that is as effective as single fraction SRS but has less complications. 

Also, is there a maximum hotspot within the target volume?  

The 2014 "Choosing Wisely" list, released this past September, includes the assertion that we should not "routinely add adjuvant whole brain radiation...

Some medical oncologists tend to hold anticoagulation in patients who develop brain metastases for fear of causing intracranial hemorrhage.  Is t...

Does the extent/duration of systemic disease control (complete response vs. stable disease, for example) influence your decision?  What about whe...

What are the best options to treat a patient with brain metastasis confined to the posterior fossa if the patient is young, has a favorable cancer, gr...

Is it based on symptoms only?  Every 3 months? 

In a patient with multiple brain metastases from NSCLC, is this reasonable?

How do the number of lesions treated and histology affect your decision making?

The most frequent argument against whole brain RT is debilitating toxicity. However, I am having a hard time finding the most evidence based data on h...

While the Duke randomized study found similar rates of control with 1mm v. 3mm margins and higher radionecrosis with 3mm, it did not look at treating ...

In RTOG 9508, 4 cm was the cut-off size for WBRT followed by SRS. 

It is my impression that for brain metastases >3 cm it may be preferable to deliver fractionated SRT versus the RTOG dose of 15 Gy SRS, if WBRT is ...